Journals Watch - Bariatric surgery and otitis media

Bariatric surgery for obstructive sleep apnoeaAm J Med 2009; 122: 535-42Despite being performed by surgeons, I am a great fan of bariatric surgery as a successful means to significant weight loss. This paper is a meta-analysis of research on whether bariatric surgery improved obstructive sleep apnoea. Twelve studies were identified, including 342 patients - not a huge number by meta-analysis standards.

Average BMI fell from 55.3kg/m2 to 37.7kg/m2 and the apnoea-hypopnoea index fell from 54.7 events/hour to 15.8 events/hour.This is a dramatic fall, but the average apnoea-hypopnoea index after surgical intervention is still consistent with moderately severe obstructive sleep apnoea, so even if the patient reports a noticeable improvement in symptoms, they should remain in treatment or be sent back to the sleep centre for repeat polysomnography.

Antibiotics for otitis mediaBMJ 2009; 338: b2,525Acute otitis media is one of the most common infections in children. Antibiotics are likely to be given, despite guidelines suggesting that the prescription of antibiotics should be the exception. Previous studies have shown that in the first six months after a prescription for antibiotics the re-attendance rate is the same as for children who received no antibiotics.

This double blind, randomised, placebo-controlled trial followed children for 3.5 years following a prescription for amoxicillin 40mg/kg/day in three doses or placebo.

They found the children given a prescription had a recurrence rate of 63 per cent compared with the children given placebo who had a recurrence rate of 43 per cent, although the confidence intervals were so wide the result had to be interpreted with caution. A factor for consideration is that providing antibiotics may validate the patient's concern, causing them to re-attend. This lends weight to the 'avoid prescribing' school of thought.

Childhood road traffic accident spinal injuriesArch Dis Child 2009; 94: 546-8The safety of being a passenger in a car has increased dramatically with the introduction of compulsory rear seatbelts and, in September 2006, regulations changed to make booster seats compulsory for children under 135cm or 12 years of age.

This Australian study looked at the risk of serious spinal injury in children up to age eight, age 8-12 and above 12 years of age. The authors found that children up to age 12 have an elevated risk of serious spinal injury in car crashes, compared with older children.

The authors conclude that as most booster seats are recommended up to age eight, manufacturers should look at modifying their seatbelt design.

They recommend the child's age should be considered when triaging a child from a road traffic accident.

This research looked at all the sickness certificates issued by a collection of practices over the course of a year.

They recorded the frequency of certificates issued according to age and Read Code chapter heading.

They found one in 10 patients will receive a sick note per year. The highest rates of certification were for patients around 50 years of age and for women. The rate of certification decreased slightly in those just below retirement age.

The most common Read Code headings were, not surprisingly, mental health and musculoskeletal.

The research can be used to assess the impact of the new 'Fit for Work' scheme, coming to surgeries in spring 2010.

Super Bowl deathsAm J Cardiol 2009; 103: 1,647-50This US research looked at cardiovascular deaths during and for the next 14 days after the Los Angeles Rams played in the Super Bowl, once when the team won and once when it lost.

The rates were compared with control days when the Super Bowl was not being played.

They found there was a significant drop in cardiovascular deaths when the team won and a significant rise when they lost.

They felt the differences were not due to different levels in activity or being overly indulgent, but due to the emotional stress of loss.

Variation in gender patterns in childhood injuryArch Dis Child 2009; 94: 524-30We all know that boys injure themselves more frequently than girls. This study set out to see if there were any patterns to this, especially over time, looking at injuries in children aged 0-14 years between 1982 and 2006 in Scotland. Overall there was an excess of injuries in boys with a male to female ratio of 1.7:1.

As children get older the excess of injuries in boys compared with girls increases. The leading causes of injury with a male excess were, in decreasing order: poisoning, falls, suicide, and pedestrian then road traffic accidents.

The only thing that did not show an excess was fire. The increase of injury with age is multifactorial with an important factor being risk taking. The excess in male injuries declined over time.

Dr Hunter is a GP in Bishop's Waltham, Hampshire and a member of our team who regularly review the journals.

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